Coronary Artery Disease
Description CAD (Coronary Artery Disease) is caused by atherosclerosis of the coronary arteries that leads to a restriction of blood flow to the heart. Depending on the degree of stenosis (Narrowing) and plaque characteristics, patients may experience stable angina (Angina pectoris) or remain asymptomatic until a plaque ruptures and thrombosis occurs, causing ACS (Acute Coronary Syndrome). Because the underlying atherosclerosis causal to CAD is a systemic disease, patients with CAD often have ischaemic vascular disease affecting two or more vascular beds (Polyvascular disease). The World Health Organization (WHO) has estimated that out more than 1 in 7 deaths in 2015 were caused by CAD. Risk Factors Multiple factors are associated with an increased risk of atherosclerotic cardiovascular disease. These are commonly categorized as: * Non-modifiable risk factors, e.g. age, gender and ethnicity, genetic disposition * Modifiable risk factors, e.g. hyperlipidaemia, hypertension, diabetes, smoking, poor diet and nutrition, physical inactivity Modifiable risk factors may be controlled by a combination of lifestyle changes and medical therapies. Co-morbidities are common among patients with CAD and are associated with an increased risk of heart attack, stroke and all-cause death among heart attack survivors. History of renal disease, heart failure, COPD (Chronic Obstructive Pulmonary Disease) and cancer have shown the strongest associations (an approximately twofold increase in risk). Symptoms Stable CAD can present with or without angina symptoms: * Approximately half of all patients present with CAD have angina as the manifestation. ** Symptoms appear or become more severe with increased levels of exertion or emotional stress. * Angina symptoms are caused by transient MI and by the release of ischaemic metabolites such as adenosine. * Stable CAD may be asymptomatic, because of a lack of ischaemia or because of impaired transmission of painful stimuli to the cortex. Mild CAD Mild CAD happens when less than 49% of your artery is blocked. Moderate CAD Mild CAD happens when 50%-70% of your artery is blocked. Severe CAD Mild CAD happens when more than 70% of your artery is blocked. Medicine Medications may be recommended to treat high cholesterol, high blood pressure, and high blood sugar. Sometimes medications for chest pain that comes on with activity are recommended. Aspirin or other blood thinners may also be recommended. Treatment Lifestyle changes * Adopting a heart-healthy eating plan * Exercising regularly * Getting to a healthy body weight * Not smoking * Managing stress Relieving symptoms of coronary artery disease * Sublingual nitroglycerin is the standard initial therapy for effort angina, because it promotes coronary arteriolar and venous vasodilation. * To control heart rate and symptoms, Beta-blockers and/or CCBs are recommended. ** Beta-blockers reduce heart rate, contractility, atrioventricular conduction and ectopic activity. ** To control heart rate and symptoms, Beta-blockers and/or CCBs are recommended. Revascularization in patients with CAD Revascularization of patients with CAD is recommended to * Improve symptoms in patients with any coronary stenosis >50% and unresponsive to optimal medical therapy * Improve prognosis in patients with significant stenosis/stenoses (>50%) that are anatomically or functionally significant Revascularization can be achieved through either PCI or CABG. The appropriate approach is dependent on the * Location of the stenosis * Extent of the disease (i.e. single versus multivessel disease) * SYNTAX score of the patient (an angiographic score that assesses lesion complexity) * Surgical risk of the patient References https://www.thrombosisadviser.com/coronary-and-peripheral-artery-disease/ https://www.cardiosmart.org/News-and-Events/2016/06/Understanding-CAD https://www.thrombosisadviser.com/coronary-artery-disease/clinical-diagnosis/ https://www.thrombosisadviser.com/coronary-artery-disease/treatment/